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Pediatricians in Canada are starting to discharge children whose parents refuse to have them vaccinated.

More and more, doctors are taking a stand when their medical advice is being ignored, said Dr. Hirotaka Yamashiro, chair of the pediatrics section for the Ontario Medical Association and president of the Pediatricians Alliance of Ontario.

“There have been some pediatricians who are very concerned about that, and may not take on the patient in the beginning,” Yamashiro said. “If you are going to fundamentally disagree with one of the things I think is good for your child, what else are we going to have a problem with?”

“Their whole philosophy on care is not consistent with how I practise my medicine,” she said. “So it’s probably better that they find a doctor who they’re comfortable with, who they can talk to, and who can handle their specific needs better than me.”

Of her more than 3,000 patients, Kamalia says she discharges less than 1 per cent, basically those with parents who “adamantly refuse” immunization. Doctors have the right to end a relationship with a patient when there is a “breakdown of trust and respect,” according to the Ontario College of Physicians and Surgeons.

Children receive their first set of vaccines at two months and in Ontario are required to get vaccines for diphtheria, tetanus, polio, measles, mumps and rubella in order to attend school. However, an unvaccinated child can attend if a medical note or a statement of conscience or religious belief is provided to the Medical Officer of Health.

Within the first month of a newborn’s life, Kamalia discusses how parents will proceed with their child’s vaccinations.

If parents have concerns about potential risks and side effects, she gives them updated medical literature to read, cites cases of people who developed illnesses because they weren’t vaccinated, and emphasizes that she has no ties to vaccine companies.

If parents are still resistant, Kamalia offers a modified vaccination schedule, and has them sign a waiver indicating that this was their decision.

Discharging patients is a “last resort,” she says. Unvaccinated children put her other patients at risk, and “at the end of the day, I have to make a decision as to how I run my practice.”

Right now, Kamalia says she has no unvaccinated patients, and a maximum of five are on modified schedules. She says in the last three to four years she’s had fewer parents raise concerns about vaccines.

Yamashiro estimates that one in 25 to 30 parents in Ontario refuse immunizations for their child, or place their child on a modified vaccine schedule. He adds that one in eight to 10 parents express concerns over how vaccines may affect their child.

“It’s a big problem because…you’re leading to more and more unimmunized children,” Yamashiro said. “If this movement is allowed to fester, it’s like a wound. If you allow it to sort of grow, then you’re going to start affecting everybody’s health.”

As recently as 10 years ago, pediatricians rarely dealt with worried parents fretting over vaccines, Yamashiro said, but the increasing wealth of online medical information has resulted in misinformation.

Yamashiro said parental fears over immunization have increased since 1998 when The Lancet, a prestigious U.K.-based medical journal, published a study linking autism with the measles-mumps-rubella (MMR) vaccine. In 2010, the journal retracted the study, led by Andrew Wakefield, who has since been stripped of his medical licence.

But there are those who are still wary of vaccines, such as Edda West, a B.C.-based grandmother and co-ordinator of the Vaccine Risk Awareness Network, a non-profit organization that provides information on the risks associated with vaccines.

West became an advocate of “vaccine awareness” 35 years ago, after her then 15-month-old daughter became sick with a high fever and developed an “atypical” case of measles. The incident led her to connect with parents who had had similar experiences.

“We believe most parents try very hard to make healthcare decisions that are in the best interest of their children,” she said. “Well-informed parents know that there is a big gap in scientific knowledge about the impact of multiple vaccines on the health of their children.”

“They are concerned because doctors are unable or unwilling to discuss these concerns rationally and without prejudice.”

Oakville mother Erika Klein, who has a 15-year-old daughter, says doctors shouldn’t discharge patients over a disagreement of treatment or immunization.

“I just think it’s wrong that just because the parents have opted out of the vaccination — why should they be denied care?” she said. “It’s a (doctor-patient) relationship based on trust, and there’s a history there.”

Klein’s daughter Morgan received all of the required vaccines, but they opted out of the voluntary ones against meningitis and human papillomavirus. Klein says her doctor, with whom she has a good relationship, recommended the shots, but “he didn’t force it on me.”

While he’s heard of other doctors turning patients away, Toronto-based pediatrician Marvin Gans says it’s best to deal with vaccine-averse parents diplomatically. He offers a delayed schedule, with the goal of eventually getting something into the child. Currently, less than 1 per cent of his patients are unvaccinated.

“If you turn them off, they may feel that nobody cares and medicine doesn’t listen,” Gans said. “And there’s no hope of them coming back.”

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